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Outcomes of chronic graft-versus-host disease following matched sibling donor versus umbilical cord blood transplant

Bone Marrow Transplantation volume 56, pages 1373–1380 (2021)Cite this article

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Abstract

We compared chronic graft-versus-host disease (cGvHD) following umbilical cord blood (UCBT) and matched sibling donor peripheral blood transplant (MSD). 145 patients (2010–2017) with cGvHD after MSD (n = 104) and UCBT (n = 41) were included. Prior acute GvHD was less frequent in MSD (55% vs. 85%; p = 0.01). Severe cGvHD (32% vs. 15%, p = 0.01) and de-novo onset (45% vs. 15%, p < 0.01) were more frequent following MSD. Liver was more frequently involved in MSD recipients (38% vs. 6%); and GI in UCBT (33% vs. 63%), both p < 0.01. Overall response (CR + PR) was similar between both cohorts. 2-year CR was higher in UCBT (14% vs 33%, p = 0.02). Karnofsky score (KPS) ≥ 90 at cGvHD diagnosis was associated with higher odds of response (95%CI: 1.42–10, p < 0.01). The cumulative incidence of durable discontinuation of immune-suppressive therapy, failure-free survival (FFS) and NRM at 2-years were similar between cohorts. KPS < 90 (95%CI: 3.1–24.9, p < 0.01) and platelets <100 × 10e9/L (95%CI: 1.25–10, p = 0.01) were associated with higher risk of NRM. UCBT patients were more likely to have a prior acute GvHD, less severe cGvHD and more likely to attain CR. Despite differences, both cohorts had similar NRM and FFS. High-risk groups, including those with platelets <100 × 10e9/L and KPS < 90, need careful monitoring and intensified therapy.

Highlights

  • cGvHD after UCBT was less severe, and had more CR to therapy than MSD transplant.

  • NRM was similar in patients with cGvHD after UCBT and MSD transplant.

  • FFS was similar in patients with cGvHD after UCBT and MSD transplant.

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Fig. 1: Chronic GvHD characterisitcs.
Fig. 2: Nonrelapse mortality by donor type.
Fig. 3: Discontinuation of Immune-suppression by donor type.
Fig. 4: Failure free survival by donor type.

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Authors and Affiliations

  1. Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA

    Grigori Okoev, Daniel J. Weisdorf, Najla El Jurdi, Shernan G. Holtan, Claudio G. Brunstein, Brian C. Betts, Veronika Bachanova, Erica D. Warlick, Armin Rashidi & Mukta Arora

  2. Department of Pediatrics, Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, MN, USA

    John E. Wagner, Bruce R. Blazar, Margaret L. MacMillan & Takuto Takahashi

  3. Division of Biostatistics, Clinical Translational Science Institute (CTSI), University of Minnesota, Minneapolis, MN, USA

    Todd DeFor

  4. Department of Blood and Marrow Transplant and Cellular Immunotherapy, Moffitt Cancer Center and Research Institute, Tampa, FL, USA

    Aleksandr Lazaryan

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  1. Grigori Okoev
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  2. Daniel J. Weisdorf
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Correspondence to Grigori Okoev.

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Conflict of interest

DJW - research support from Incyte. JEW - advisor at Magenta Therapeutics. BRB - founder of Tmunity Therapeutics, advisory board member for Kadmon Pharmaceuticals, Magenta Therapeutics, and BlueRock Therapeutics and receives research funding from BlueRock Therapeutics. SGH – consultant for Incyte, Bristol Meyers Squibb, and Generon.

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Okoev, G., Weisdorf, D.J., Wagner, J.E. et al. Outcomes of chronic graft-versus-host disease following matched sibling donor versus umbilical cord blood transplant. Bone Marrow Transplant 56, 1373–1380 (2021). https://doi.org/10.1038/s41409-020-01195-5

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